Abstract
Chronic total occlusion (CTO), affecting 18 to 30% of coronary artery disease patients
undergoing angiography, is linked to refractory angina, reduced left ventricular function,
and increased arrhythmia risk. This article synthesizes indications, evidence, and
guidelines for CTO revascularization, focusing on percutaneous coronary intervention
(PCI). CTO PCI achieves over 85% success rates in expert hands, with randomized controlled
trials showing improved symptom relief and quality of life, though mortality or ventricular
function benefits remain unproven. The 2021 ACC/AHA/SCAI and 2018 ESC/EACTS guidelines
recommend CTO PCI for refractory angina, emphasizing operator expertise and shared
decision-making. Controversies persist regarding prognostic benefits and patient selection.
Ongoing trials aim to clarify these issues. This review equips clinicians with a framework
to navigate CTO management, balancing evidence and patient-centered care.
Keywords
coronary artery - coronary intervention - chronic total occlusion - guidelines - indications
- coronary angiography
